肠内营养可减少标准胰十二指肠切除加 Child 重建术后的胃排空延迟。
Enteral nutrition reduces delayed gastric emptying after standard pancreaticoduodenectomy with child reconstruction.
机构信息
Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Université de Rennes 1, Rennes, France.
出版信息
J Gastrointest Surg. 2012 May;16(5):1004-11. doi: 10.1007/s11605-012-1821-x. Epub 2012 Jan 19.
BACKGROUND
Delayed gastric emptying (DGE) is a common complication following pancreaticoduodenectomy (PD). Our retrospective study aimed to evaluate the influence of enteral nutrition (EN) on DGE incidence after standard PD with antrectomy and Child reconstruction.
METHODS
We retrospectively analyzed 275 consecutive patients who underwent standard PD between January 2000 and September 2009. Patients operated on after January 2005 received EN (EN group, n = 152) until total oral alimentation. Patients operated on prior to 2005 did not receive EN (control group, n = 123) and were orally fed after removing the nasogastric tube. Primary endpoint was the incidence of DGE according to the International Study Group of Pancreatic Surgery criteria. Secondary endpoints were the incidence of any other complications.
RESULTS
The incidence of DGE was 26% vs. 38% (p = 0.04) in the EN and control groups, respectively, with 17% vs. 19% for grade B DGE (NS) and 9% vs. 19% for grade C DGE (p = 0.02). The differences in DGE did not significantly decrease the duration of stay (18 ± 11 vs. 19 ± 13 days; NS). Postpancreatectomy hemorrhage was significantly reduced in the EN group (8% vs. 20%, p = 0.008), with the incidence of postoperative pancreatic fistula being similar in both groups (15% vs. 12%; NS). Using multivariate analysis, EN (p = 0.047, OR = 0.559 [0.315; 0.994]), operative time (p < 0.001, OR = 1.007 [1.003; 1.010]), and patient age (p = 0.014, OR = 1.031 [1.006; 1.057]) were independent factors affecting the incidence of DGE.
CONCLUSIONS
EN reduces DGE and postpancreatectomy hemorrhage after PD.
背景
延迟性胃排空（DGE）是胰十二指肠切除术（PD）后的常见并发症。我们的回顾性研究旨在评估标准 PD 加抗胃切除术和 Child 重建术后肠内营养（EN）对 DGE 发生率的影响。
方法
我们回顾性分析了 2000 年 1 月至 2009 年 9 月期间连续接受标准 PD 的 275 例患者。2005 年 1 月后手术的患者接受 EN（EN 组，n=152）直至完全口服喂养。2005 年前手术的患者未接受 EN（对照组，n=123），在拔除鼻胃管后进行口服喂养。主要终点是根据国际胰腺外科学研究组标准评估的 DGE 发生率。次要终点是任何其他并发症的发生率。
结果
EN 组和对照组的 DGE 发生率分别为 26%和 38%（p=0.04），DGE 分级 B 分别为 17%和 19%（无统计学差异），DGE 分级 C 分别为 9%和 19%（p=0.02）。DGE 的差异并未显著缩短住院时间（18±11 天 vs. 19±13 天；无统计学差异）。EN 组的胰周术后出血明显减少（8% vs. 20%，p=0.008），两组术后胰瘘发生率相似（15% vs. 12%；无统计学差异）。多变量分析显示，EN（p=0.047，OR=0.559[0.315；0.994]）、手术时间（p<0.001，OR=1.007[1.003；1.010]）和患者年龄（p=0.014，OR=1.031[1.006；1.057]）是影响 DGE 发生率的独立因素。
结论
PD 后 EN 可降低 DGE 和胰周术后出血的发生率。
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